Cross-Cultural Validation Study of Emotion-Based Social Skills Training for Children with Autism

Background:

Emotion-based Social Skills Training (EBSST; Wong et al., 2010) is a manualized therapy program that enhances the emotion competence of children with Autism Spectrum Disorder (ASD), reduces symptoms of mental disorders, and develops emotion coaching skills for parents and educators (Ratcliffe, Wong et al., 2014). EBSST was developed and evaluated in an English-speaking, Australian school context. EBSST program fidelity and effectiveness in other language and cultural groups is yet to be explored. Lau (2006) outlines methods of cultural adaptation of mental health interventions and highlights that cultural sensitivity to the values, concepts and ideas around children, families, disability, and mental health needs to be applied. In the ASD literature, two cross-cultural adaptation studies have been described for manualized social skills interventions: PEERS (Laugeson & Frankel, 2010; Yoo et al., 2014) and KONTAKT (Herbrecht et al., 2007; Olsson et al., 2016). In this study the cultural adaptation of EBSST to Chinese settings was undertaken. This was a joint project between Transcultural Mental Health Centre, who provide mental health interventions to people from culturally and linguistically diverse communities and the Children’s Hospital at Westmead, where the EBSST program was developed and researched.

Objectives:

The aims of this study were: (i) develop a protocol for the cultural and language adaptation of EBSST; (ii) evaluate the effectiveness, feasibility and acceptability of Emotion-based Social Skills Training being delivered by bilingual psychologists to children with Autism and their families from the Australian-Chinese community; and (iii) identify adjustments to English-language EBSST that need to be made to maintain fidelity of the EBSST program for children with Autism and their families from the Australian-Chinese community.

Methods:

A convergent mixed-method approach involving quantitative and qualitative evaluation was applied. Six children with ASD aged 8 to 12 years and their parents from the Australian-Chinese community were recruited. Eligibility assessments were conducted using the Autism Diagnostic Observation Schedule (Lord, 2000) and cultural assessments were conducted based on the DSM-5 cultural formulation approach (American Psychiatric Association, 2013). Bilingual psychologists were trained and certified as EBSST facilitators and delivered 16 group EBSST sessions to children. Six group EBSST sessions to parents were delivered in the Chinese language, with culturally appropriate adaptations. Quantitative data on child emotions development and child and parent mental health was collected pre- and post-treatment. Qualitative data on treatment acceptability and feasibility was collected from children, parents and psychologists from questionnaires and semi-structured interviews.

Results:

EBSST for Australian-Chinese families demonstrated improvements on quantitative measures of child emotions competence and child and parent mental health pre- and post-treatment. Children, parents and psychologists all rated the intervention as acceptable and feasible.

Conclusions:

Cultural and language adaptations are important to consider when developing and delivering therapeutic interventions to children with ASD and their families from different cultural groups. The findings of this study will inform an international research collaboration between Australia and China where a control group trial of EBSST in a school for 80 children with Autism in China will be undertaken.